PLUMBING PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
D ate A ll� � L t 2 °O \ Job Address y50 t' c ki Tax Folio
Legal Description
Owner/Lessee / Tenant M tAX1 CLAN) V1 o --f
rrer's Address `\SO NE 1` S . W∎A c tALk SA.49-49 s / c L 3111
11,4 , 97 LCkk // Ooh / 7///1)6' Address
Contracting Co.
Qualifier / L ` /47 6;e/9 2I9 - ' Z-
State # - ,2 //O 4/f Municipal # Competency #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRIC
WORK DESCRIPTION / e / / ( ' , 1 / D / ) ai e i / * � T J A ) K E v 4 - , S \I S re V>n
Square Ft. Estimated Cost (value) 1 00
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction m this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
S ignature of owner and/or Condo President
Notary as to
My Commis
FEES: PERMIT
Date
*� ROSE MARIA BURKE - MORGAN
, MY COMMISSION # CC 880439
PBDttii Uhderwdters
gniXigg
Date
Wry
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RADON C.C.F. 1'
Historically Designated: Yes No
SS# ,, Phone 3 'S - 3V95V
Ins. Co. M 5� 6
Address
Address
Address
ECHANICAL ROOFING PAVING FENCE SIGN
Notary a o ontractor or
My Co ssion Expires:
NOTARY
Master Permit # gp..3
SAPhone 3 0 S ) S I. 8
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v �
sf, /0 a) AD /),e, �3 s
4'•- /t-O/
er- iii�4Y
FIE; E) V; I: Lit Date
COM V! I N NO. CC%14103
My CGM:.0 S1ON F.N MAN.12t11
BONDS oQ 6 0
J
APPROVED:
Zoning Building Electrical
Mechanical Plumbing
TOTAL DUE
Structural Engineer
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIN))
DISPOSAL
SERVICE TEM'CRARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AAPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TCP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTCRS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 C04P.
MOTORS OVER 3- 5 FP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEM3LIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEWORARY WATER CLOSET
MOTCRS OVER 10- 25 FP
FIRE SPRINKLER SYSTEMS
URINAL
MOTCRS OVER 25-100 FP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 NP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
CUTLETS COhf.RCIAL
WATER SERVICE
SIGN TUBES
;EWER CONNECTIONS
SIGN TRANSFORMERS
.
JTILITY -SEWER
SIGN TIME CLOCK
JTILITY -WATER
FIXTURES
;EPTIC TANK
{HENNA
'ELAY
TELEVISION OUTLETS
:RAINFIELD, 4' TILE/RES.
VIOLATION
'UI<P & ABANDON SEPTIC TANK
REINSPECTION
.
;OAKAGE PIT CU. FT.
.ATCH BASIN
I I SCHARGE WELL Z,,, f / fi
/
OMESTIC WELL
REA DRAIN
OOF INLET
OLAR WATER HEATER
IRE STANDPIPE
001 PIPING
AWN SPRINKLER SYSTEM
^ _
AS RANGE
:TER SET (GAS)
AS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
Permit No
7 e s,
v�
-
Amount of Permit $ �?
STATE OF FLORIDA,
COUNTY OF DADE. j
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed )_
( Signed �icdIL
Date. -- / - /-- .. ?i ‘9,
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. L
Owner's Name and Address L �� ��'� � " No. Street
Registered Architect and /or Engineer �p
Employing Plumber's Name_ )-k - _ b '` e- No. 1 �.^_- /1 1 S k - _._
Location and Legal Description Lot. B1 / Subdivision E L �
Street and Number where work is to be performed —No £ L Street_
State work to be performed and purpose of building (By Floors)*
New Building.._ -_ — Remodeling__ __ ________ Addition._._____ Repairs No. of Stories... ..............
Size Septic Tank_ -- _____ —.__ -- Type of Tank
Feet of Drain ............... Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well.____________ __________________________Size of Soakage Pit
Capacity Gals.
My Commission Expires Notary Public, State of Florida
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o.,7tions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pen , nt Supplement, and bus com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors el ployed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUB6
SHOWERS
-
TORIEG
SINKS
SLOP
SINKS
L-"TUBS"'
URINALS
BASIN
DRAIN
FOUNT' 6
S dtp-
X1_11
TOTAL
IKTUREB
_
CONTR.
LIST
r
1
O
CJ 6a � di /
I
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
- -.
Permit No
7 e s,
v�
-
Amount of Permit $ �?
STATE OF FLORIDA,
COUNTY OF DADE. j
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed )_
( Signed �icdIL
Date. -- / - /-- .. ?i ‘9,
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. L
Owner's Name and Address L �� ��'� � " No. Street
Registered Architect and /or Engineer �p
Employing Plumber's Name_ )-k - _ b '` e- No. 1 �.^_- /1 1 S k - _._
Location and Legal Description Lot. B1 / Subdivision E L �
Street and Number where work is to be performed —No £ L Street_
State work to be performed and purpose of building (By Floors)*
New Building.._ -_ — Remodeling__ __ ________ Addition._._____ Repairs No. of Stories... ..............
Size Septic Tank_ -- _____ —.__ -- Type of Tank
Feet of Drain ............... Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well.____________ __________________________Size of Soakage Pit
Capacity Gals.
My Commission Expires Notary Public, State of Florida
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o.,7tions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pen , nt Supplement, and bus com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors el ployed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.